2019 GROW GREAT SEMINAR · 3 Micronutrient fortification (iron and salt iodization) Malnutrition 4...

#GrowGreatSeminar2019

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2019 GROW GREAT SEMINARZero Stunting by 2030- An opportunity for greatness!

18 October 2019 | Gauteng, South Africa

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WELCOMEIman Rappetti


DR KOPANO MATLWA MABASOExecutive Director, Grow Great Campaign

DR TSHEPO MOTSEPEKeynote address

DR RICHARD PENDAMERegional director, Nutrition International

9

STUNTING AND PROGRAMMATIC RESPONSES -

A REGIONAL OVERVIEW

GROW GREAT SEMINAR ON STUNTING

18TH OCTOBER 2019

Presentation by

Dr Richard Pendame

NI Regional Director, Africa

10

OUTLINE

Background

What is stunting and its burden

Programmatic response

Conclusion

Nutrition International

A global nutrition organization headquartered in Canada

27 years history

Operate in 10 core countries

Over 600 staff worldwide

Regional Offices in Kenya and India

Reach > 500m people/year


Technical assistance in > 20 Sun Countries

Vitamin A programing in 55 countries

Reaching 150-180 M children a year.


NI’s global programming has averted:

5 million child deaths

10 million cases of stunting

1.6 million permanent mental impairments

Half a million cases of anemia among women

What is Stunting?

14

15

Faces of Stunting

Photo credit: Tom Maguire/RESULT

16

Effects of stunting on a child’s brain

Stunted growth Never Stunted growth

What are the Impacts of Stunting?

17

Impact Stunting

Health

• Stunted children are sick more often and 4X more likely to die.

Poor immunity

Reduces effectiveness of vaccines

NCDs

Impact of Stunting

Education

• Reduced cognitive development combined with poor health impacts education outcomes.

Impact of Stunting

Earnings

• Reduced education outcomes combined with poor health impacts earning potential.

• This perpetuates the cycle of poverty and malnutrition.

• In women, this also impacts economic independence and choice.

Impact of Stunting

Economic Growth

• Reduced education outcomes and earning potential impacts the future of entire countries.

• Reduced tax revenue limits countries abilities to provide social services such as education and health care.

Impact of Stunting

Health System Costs

• DMS = increased burden

to health care system.

What is the Burden of Stunting?

23

Stunting: Global Burden

UNICEF, WHO, World Bank Group

Joint Child Malnutrition

Estimates

Key findings of 2018 edition

26

Percentage of stunted children under 5

Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019

27

Stunting numbers by region


28

Trends in % of stunted children <5 in Africa

(2000 - 2018)


2018 Global Nutrition Report

Global Nutrition Targets for 2025

TARGET 1:

40% reduction in the

number of children

under 5 who are stunted

TARGET 2:50% reduction of anaemia in women of reproductive age

TARGET 3:30% reduction in low birth weight

TARGET 4:No increase in childhood overweight

TARGET 5:Increase the rate of exclusive breastfeeding in the first 6 months to at least 50%

TARGET 6:Reduce and maintain childhood wasting to less than 5%

30

WHA Nutrition Targets - Progress

Countries on course:

1. Burkina Faso2. Egypt3. Ghana4. Kenya5. Eswatini6. Liberia7. Cote d’Ivoire

Source: Global Nutrition Report 2018

31

Ranking of solutions

Copenhagen consensus

Solution Challenge

1 Micronutrient supplements for children (A &

zinc)

Malnutrition

2 The Doha development agenda Trade

3 Micronutrient fortification (iron and salt

iodization)

Malnutrition

4 Expanded immunization coverage for children Diseases

5 Biofortification Malnutrition

6 Deworming, other nutrition programs in

school

Malnutrition

7 Lowering the price of schooling Education

8 Increase and improve girl’s schooling Women

9 Community-based nutrition programs Malnutrition

32

Critical steps to speed up progress

Conclusion Stunting is major public health problem for Africa

with health and non health long term effects.

Progress in reduction of stunting has been slow

Proven specific and sensitive nutrition interventions exist but need scaling up.

Tackling stunting requires bold multi-sectoral action, leadership and financing.

THANK YOU

36

TEA & POSTER PRESENTATIONS


BEATING STUNTING-Case studies from developing country counterparts

DR THERESA SHAMAH

Deputy Director General,

National Institute of Public Health,

Mexico

39

Beating Stunting:

Case studies from

developing country

counterpartsDra. Teresa Shamah Levy

Deputy Director of the

Centre of Research of Evaluation and Surveys

National Public Health Institute

October, 18 2019

[email protected]

Public Policies in

Mexico to reduce

Stunting

40

ABOUT TODAY´S SESSION

Nutrition status in Mexico

PROSPERA EsIAN

Current Public Policies By the New Mexican Government

2019-2024

41

BEFORE BEGINNING………….

•I do not have any conflicts

of interest

42

EVOLUTION OF NUTRITION STATUS OF CHILDREN <5 Y

IN MEXICO

43

%

NATIONAL PREVALENCES OF MALNUTRITION IN CHILDREN <5 YEARS OLD FROM1988-2016. RESULTS FROM THE NATIONALHEALTH AND NUTRITION SURVEYS

10,8

26,9

6,27,8

5,6

21,5

2,1

8,8

3,4

15,5

2

8,3

2,8

13,6

1,6

9,7

3,9

10

1,9

5,86,0

27,0

3,0

13,0

0

5

10

15

20

25

30

Underweight Stunting Wasting Overweight and obesity

ENN 1988 ENN 1999 ENSANUT 2006 ENSANUT 2012 ENSANUT MC 2016 SOUTH AFRICA2016

44

National prevalence of low height for age in

children <5 y (1988-2016)

1988 1999 2006

2012 2016

More than 20% (2)

From 15% to 20% (0)

From 10% to 15% (2)

Less than 10% (0)

Categories of

Prevalence

45

NATIONAL PREVALENCES OF MALNUTRITION IN CHILDREN <5 YEARSOLD, 2016. RESULTS FROM THE NATIONAL HEALTH AND NUTRITION SURVEYS IN MEXICO-SOUTH AFRICA

3,9

10

1,9

5,86,0

27,0

3,0

13,0

0

5

10

15

20

25

30

Underweight Stunting Wasting Overweight and obesity

ENSANUT MC 2016 SOUTH AFRICA

Source: South African Demographic Survey (SADHS), 2016

2016

46

DROP OF THE NATIONAL PREVALENCE OF EBF

20

46

17

35

14

24

3

22

34

22

30

14

33

18

14,5

27

1316

13 13

22

0

5

10

15

20

25

30

35

40

45

50

Nacional Indígenas No Indígenas NSE más bajo NSE más alto Educaciónmaterna 1-<6a

Educaciónmaterna >14a

1999

2006

2012

Pre

vale

nce

5.6 pp

González de Cossío T et al.SPM. 2013;55 suppl 2:S170-S179.

National Indigenous Not indigenous Low

HWIHigh

HWI

Maternal

education 1-<YMaternal

Education >14Y

HWI: Household Wealth Index

47

Source: ENN 88 y 99, ENSANUT 2006 Y 2012, ENSANUT Medio Camino (half -way) 2016

18,6 20,8 19,5 15,4 20,0 19,6 18,5

40,9 42,5 42,6 41,79,6

16,6 17,418,3 13,0 14,5 15,0

18,524,2 26,8 27,7

28,2

37,4 36,933,7 33,0 34,1 33,5

59,4

66,7 69,4 69,4

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

1999 2006 2012 2016 2006 2012 2016 2000 2006 2012 2016

Niños escolares (5 a 11 años) Hombres Adolescentes (12-19 años) Hombres Adultos (20 y mas años)

Sobrepeso Obesidad

17,2 19,7 20,2 20,69,0

21,9 22,5 23,7 26,4 25,136,3 37,0 35,3 35,6

8,312,6 11,8 12,2

2,1

6,410,9 12,1

12,89,5

24,732,6 35,2 37,1

25,532,3 32,0 32,8

11,1

28,3

33,435,8

39,2

34,6

61,0

69,670,5 72,7

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

1999 2006 2012 2016 1988 1999 2006 2012 2016 1988 1999 2006 2012 2016

Niñas escolares (5 a 11 años) Mujeres adolescentes (12 a 19 años) Mujeres adultas (20-49 años)

Sobrepeso Obesidad

Female

Male

School-age girls (5-11 years) Female adolescents (12-19 years) Women adults (20-49 años)

School-age boys (5-11 years) Men adolescents (12-19 years) Men adults (20-49 years)

Overweight Obesity

Overweight Obesity

National Prevalences of overweight and obesity by age and sex groups

* Classification system proposed by WHO

48

National Prevalences of overweight by sex and age groups in Mexico- South Africa 2016

Source: ENSANUT Medio Camino, 2016 /South African Demographic Survey (SADHS), 2016 * Classification system proposed by WHO

20,6

15,4

26,4

18,5

28,1

12,0

27

8,6

0

5

10

15

20

25

30

Female Male Female Male

School Age (5-11 years) Adolescents (12-19 years)

ENSANUT MC 2016 South Africa 2016

49

Integral Actions

(General Population)

Education

Health

Social Protection

Job training

Housing

Focused Actions(Population in Poverty)

Human Capital Development

Education

Health

Feeding

Focused Actions(Population in Poverty)

Income opportunities

Financial, Productive and Labor market inclusion

Safe water, sanitation, rural highways, communications and housing

SOCIAL POLICY DEVELOPMENT

PROGRESA

1997OPORTUNIDADES

2006

PROSPERA

2013PROSPERA-2014

Modificado de: 1575-DS ASF“EVALUACIÓN DE LA POLÍTICA PÚBLICA DE PROSPERA PROGRAMA DE INCLUSIÓN SOCIAL”, p23.

51

• A conditional cash transfer program to improve public

service utilization.

• Mexican Social Development, Health and Education

Ministries.

• Covers over 6.1 million families and 26 million people.

PROSPERA (1997-2018)

52

PROSPERA PROGRAM SCHEME: LACTATION AND PREGNANT WOMEN.CO-RESPONSIBILITIES

• Pregnant women and in Lactation period: 30 USD/monthCash transfer

• Once a month at Medical Units

Antenatal care

• Pregnant women

• Lactation Period throughout 2 yearsSuplementation

• Attend workshops on different thematics: antenatal care; familar plannification; papanicolao, weight gainWomen

53

PROSPERA PROGRAMSCHEME: MOTHERS/CHILDRENCO-RESPONSIBILITIES

• Children <5 years, 30 USD/monthCash transfer

• Once a month at Medical UnitsNutrition monitoring

• All children < 2y and undernourished childrenfrom 2 to 5 y Supplementation

• Attend workshops on different thematics: EBF; complementary feeding; supplementationMothers

54

National Integrated Nutritional Strategy

Integral Strategy for Nutrition Attention

55

WHAT IS

A national strategy to strengthen the health and nutritional

component of Prospera to address the nutritional transition in

Mexico and to improve the health and nutrition of

beneficiaries.

?

56

ESIAN:• Strategies of proven efficacy and effectiveness

• Focused on the 1,000 days

• To address both under nutrition and obesity with a

life cycle approach

• Evidence based on external evaluation and efficacy

studies in the context of the program

• Systematic process

• Systematic thinking

57

Pregnancy 0-6 m 7-23 m 24-59 m

An integrated MIYCN strategy

• Promotion of healthy

eating and physical

activity.

• Appropriate weight gain.

• Anemia prevention

(Tablets).

• Promotion of

breastfeeding.

• Exclusive

breastfeeding.

• Nutrition

assessment.

• Complementary

feeding practices.

• Nutrition

assessment.

• Use of MNP and

other supplements.

• Healthy eating

and physical

activity.

• Nutrition

assessment.

• Use of MNP.

58

COMPONENTS

Health Units

Equipment

Behavior changecommunication

and training(BCC)

Supplementation

(MNP)

*BCC strategy based on Social Marketing

59

SuplementationU

rba

n

Pregnancy and

lactation 6-11 m 12-23 m 24-59 m

Ru

ral

+ +

60

BCC USES MUTUAL REINFORCING :ACTIVITIES, CHANNELS AND MATERIALS AT MANY LEVELS.

Physicians

26,146

Nurses

36,594Health promotors

10,709

CHWs

(Community Healthworkers)

22,922

• BCC materials distributed to 14,886 health clinics

• 94, 877 health workers trained (Dec 2018)

61

TASK DEFINITION - ESIAN

Physicians

•Antenatal care

•Well child visit

•Growth monitoring

•Simplified counseling: key messages.

Nurses

•Supplement distribution

•Breastfeeding workshop.

•Growth monitoring

•Key messages

Health promotors

•Healthy pregnancy workshop.

•Complementary feeding workshop (use of supplement)

CHWs

• Household visits to reinforce key messages:

• Use of supplement during pregnancy.

• EBF.

• Complementary feeding 6-24 m.

• Supplements.

62

SUPPORT MATERIAL - ESIAN

Physicians

•Desktop flipchart.

•Health Clinic Manual.

•Supplements.

Nurses

•Breastfeeding flipchart.

•Health Clinic Manual.

•Supplements.

Health promotors

•Healthy pregnancy flipchart.

•Complementary feeding flipchart.

•Health promotor manual.

CHWs

•Household visits material:

•Healthy pregnancy.

•EBF.

•Complementary feeding 6-24 m.

•Supplements.

63

ONLINE TRAINING

64

LOW HEIGHT PREVALENCE IN CHILDREN < 5 YEARS BENEFICIARIES OF PROSPERA PROGRAM BETWEEN 2012 AND 2018.

15,513,4

26

19,9

0

5

10

15

20

25

30

PROSPERA PROSPERA

2012 2018

Urbana Rural Total

17.8

20.7

65

AT THIS TIME THE PROGRAMGRANTS DIRECTLY TO THESCHOOL-CHILDREN A WELFARESCHOOLARSHIP “BENITOJUAREZ”: 80 USD/BIMONTHLY

PROSPERA IS A SCHOOLARSHIP PROGRAM AIMED AT PRESCHOOL,

ELEMETARY AND JUNIOR-HIGH STUDENTS

66

Current Public PoliciesBy the New Government

2019-2024

67

EARLY CHILDHOOD

HEALTH

LEARNING

OPPORTUNITIESSAFE AND

PROTECTION

NUTRITION

69

INTEGRAL ROUTE FOR THE ATTENTION OF FIRST CHILDHOOD

THE ROUTE OF CARE ESTABLISHES A SERIES OF MINIMUM ACTIONS AND DIFFERENTIATED SERVICES FOR THE

INTEGRAL DEVELOPMENT OF GIRLS AND BOYS FROM 0 TO 6 YEARS OF AGE, IN HEALTH AND NUTRITION;

EDUCATION AND CARE; SOCIAL PROTECTION, CHILDREN PROTECTION AND SOCIAL DEVELOPMENT

COMMISSION FOR FIRST CHILDHOOD

HEALTH

AND

NUTRITION

70

Dr. Teresa Shamah Levy

CIEE-INSP

[email protected]

DR HELIA MOLINA

Former Minister of Health & current dean of the

Faculty of Health Sciences,

University of Santiago,

Chile

73

CHILEAN EXPERIENCE IN CHILD

UNDERNUTRITION AND STUNTINGHelia Molina MD.MPH

Dean of Medical Sciences Faculty

University of Santiago Chile

74

ANTECEDENTS

Optimal nutrition the

first 1000 days of life

• Associated with less Infant Mortality• Well nourish Children learn better at school• Well nourish adults and healthy are more

productive• A better nutrition is the entry point to end

poverty have a better quality of life andsustainable development of a country

Chronic

Malnourishment in

Children

Probably one of the best indicators to capturethe most important dimension of socialproblems of the country, including povertysocial exclusion and low coverage of social andhealth services.

75

CAUSES OF MALNOURISHMENT IN CHILDREN

BASIC CAUSES

UNDERLYING CAUSES

IMEDIATE CAUSES

INFANT

MALNOURISHMENT

POVERTY INEQUITUESLACK OF EDUCATION

OF THE MOTHER

LACK OF

ACCESS TO

FOODS

LACK OF HALTH

CARE

LACK OF WATER

AND SANITATION

INSUFICIENT

FOODINADECUARE CARE DISEASES

La desnutrición inafntil: causas, consecuencias y estrategias para su prevención y tratamiento, UNICEF, 2011

76

HISTORY OF CHRONIC MALNOURISHMENT IN CHILE

First half of

XX century

Food insecurity and highmalnourishment of motherand childrenInfant Mortality was over200 per 1000 newborn.

Economic situation of thecountry not veryencouraging with a grossinternal product ofUS$1.800year 1950, verysimilar to the average ofLAC

The state initiatesstrategies, plans andprograms in Health ,nutrition and otheractivities to increasethe level ofeducation, socialprotection andeconomicdevelopment of thecountry

77

NUTRITIONAL STATUS OF CHILE 2016

Informe de vigilancia del estado nutricional de la población bajo control y lactancia materna en el sistema público de salud de Chile, MINSAL, 2016

78

INFANT MALNOURISHMENT IN CHILE TODAY

• La prevalencia de desnutrición en los niños controlados en el sistema público de salud se

mantiene estable desde el año 2005 al año 2016, con valores bajo el 1%.

Informe de vigilancia del estado nutricional de la población bajo control y lactancia materna en el sistema público de salud de Chile, MINSAL, 2016

79

UNDERNUTRITION CHILE 1960-2009

.

YEAR Desnutrición

Leve %

-2DE a <-1 DE

Desnutrición

Moderada %

-3 DE a < -2 DE

Desnutrición Grave %

< -3DE

Total

%

1960 31,1 4,1 1,8 37,0

1970 15,8 2,5 1,0 19,3

1980 10,0 1,4 0,2 11,5

1990 7,7 0,2 0,1 8,0

2000 2,6 0,2 0,1 2,9

2009 2,4 0,4 - 2,8

Fuente: Monckeberg F, 2003; Jiménez de la Jara J, 2009, Minsal 2010.

1960 y 1970 Criterio de Gómez; 1980 y 1990 referencia Sempé; 2000 referencia NCHS; 2009 referencia OMS

80

INFANT AND MATERNAL MORTALITY

DEIS, MINSAL

81

DRINKING WATER AND SANITATION

Ministerio de Salud, elaborado por Monckeberg (2003).

82

MAIN STRATEGIES

SOCAIL

POLICIES

Priority to defat hunger and malnourishment as a policy ofthe StateContinuity of the intervention over different governmentsfrom different political parties.Strong participation of the Universities and the Scientificsocieties.Social Movement on favor of a quality of nutrition

CONCRETE

ACTIONS

Primary Health Care with a health TEAMCreation of the National Program of delivering nutritionalproducts linked to health control activities .Natality control

Increase in the educational level of the population

Increased availability of drinking water and sewerage

Public-private partnerships in search of technological

and productive

83

POLICIES DEVELOPMENT

Since the middle of XX century public policies were

developed focusing in ending malnourishment in

Children .

Supplementary

Feeding Program

(PNAC): Delivery of

food to all children

served in health

services (primary

prevention)

More frequent health controls and reinforced food deliver to children at risk of malnourishment or mild malnutrition (secondary prevention)

Hospitalization in rehabilitation centers of The Corporation of Child Nutrition (CONIN) for those infants with moderate to sever malnutrition (tertiary prevention)

84

HISTORY OF CHILEAN POLICIES

INFANTPATRONAGE

1901

Develoment of MILK DropdInitiative”

1906 1924 1934

Creation of the Ministry of Health , and Social Protection and National Council for Nutrition.

Legislation ofhealth controlof mother andchildren lesstan 2 years andfood deliver

1937

“NationalHealthSystem”

1952

LAW of mandatoryworkersinsurance/“Nationalprogram of milk deliver”

1954

Supplementary

Feeding

Program

(PNAC):.(PNAC)

1950-1060

NationalStrategyagainstdiarrhea

1971-1973

Half a literof milkcampaign

Corporation forChild Nutrition(CONIN)

1976

85

OTHER IMPORTANTMILESTONES

1. Family Planning programs and increase in the educational

level of the mother allowed significant reduction in fertility

rates a trend that was attenuated in the 90s

2. There was also a significant impact in maternal mortality

3. From the 602 school population feeding programs were

developed,

4. Vaccination programs .

5. Nursery networks developed

6. Breast feeding

7. Food fortification : iron , flour,

8. Food programs .

.

86

HUMAN RESOURCES , RESEARCH

AND KNOWLEDGE MANAGEMENT

The training of human resources (pre and postgraduate) related to food

and nutrition has been prioritized, achieving an adequate level of

knowledge and experience in professionals and technicians working I

n primary care (nurses, nutritionists, midwives, doctors, paramedics)

University Research focus on nutrition INTA

87

MONITORING AND EVALUATION

The efficient nutritional surveillance system has

allowed since 1975 a continuous record of the

nutritional status of 1.2 million children and pregnant

women controlled in the public health system In

addition, a system of information on the prevalence of

low birth weight was established in maternity

hospitals, which together with the information on infant

mortality recorded in Chile since 1904, allowed for very

strict monitoring of malnutrition in Chile

88

NATIONAL SUPPLEMENTARY

FEEDING PROGRAM (PNAC):

It is created in 1954

It presents an uninterrupted history of more than half a century

Its purpose is "to contribute to maintain and improve the nutritional

status of the population" It points to the control of malnutrition problems,

with an initial emphasis on deficit malnutrition, then incorporating

problems of excess malnutrition It is universal in nature and

considers a set of preventive and recovery nutritional support

activities, through which food is distributed to children under 6,

pregnant women and nurses

89



Hace 50 años Hoy

Food delivery is made through the establishments of the Primary

Health Care network Currently, the PNAC distributes a year close to

16 million kilos of various foods throughout the country, where dairy

products represent 98% of the total volume

90



Angelitos Salvados. Jiménez de la Jara, J. Uqbar Editores, Santiago 2009

91

PROGRAMA NACIONAL DE ALIMENTACION

COMPLEMENTARIA (PNAC)

Angelitos Salvados. Jiménez de la Jara, J. Uqbar Editores, Santiago 2009

92

LESSONS LEARNED

PUBLIC POLICIES OF THE STATE.

SUSTEINABILITY OF INTERVENTIONS.

STREGHTHENING OF PRIMARY HEALTH CARE AND HUMAN

RESOURCES DEVELOPMENT

COMMUNITY PARTICIPATIONA INVOLVING KEY

STAKE HOLDERS AND CIVIL SOCIETY.

PUBLIC PRIVATE PARTNERSHIPS IN THE SEARCH FOR

TECHNOLOGICAL AND PRODUCTIVE SOLUTIONS.

HEALTH: UNIVERSAL HEALTH CHECKS AND FAMILY PLANNING.

INCREASE THE EDUCATIONAL LEVEL OF THE POPULATION.

INCREASED AVAILABILITY OF DRINKING WATER AND SEWERAGE.

MONITORING SYSTEMS TO ASSESS COMPLIANCE WITH

THE PROPOSED GOALS

SUPPLEMENTARY FOOD PROGRAMS

93

¿IS IT POSSIBLE TO ERRADICATE

CHILD MALNUTRITION ?

Yes, but together, among several institutions , and with different

actions sustained over time.

The greatest impact is achieved in interventions aimed at pregnant

women,

lactation period and children under 3 years = damage reversibility stage.

(1000 days).

Promotion, primary and secondary prevention.

Actions to cure.

Virtuous circle of good nutrition

94

FINAL REFLECTION

The Chilean experience allows us to suggest that it is possible

to eradicate child malnutrition before reaching good levels of

economic development in the country, with state commitment,

alignment of public policies, strengthening of the health system,

political will and concrete actions to improve maternal and child health

DR RAJESH KUMAR

Former Mission Director, Poshan Abhiyaan

& current Principal Commissioner,

Delhi Development Authority,

Government of India

97

CHILDREN, NUTRITION &

VULNERABILITIES

98

151 Million Children Under 5 Years are Stunted across the World

Global Nutrition Report, 2018

99

Data Source: WDI 2016

0

20

40

60

1990 1995 2000 2005 2010 2015

Pre

vale

nce (

%)

GLOBAL

SOUTH ASIA

SUB-SAHARAN AFRICA

EAST ASIA & PACIFIC

MIDDLE EAST & NORTHAFRICA

LATIN AMERICA &CARIBBEAN

EUROPE & CENTRAL ASIA

Global and Regional Trends in Child Stunting

100

CHILD WITH STUNTED BRAIN

HEALTHY, CARED FOR CHILD

Source: Nelson, 2017

HEALTHY, CARED FOR CHILD

Significance of first 1000 Days

102

37,4

19

30,1

63

50,947,2

24,1

43,7

71,5

57,4

31

20

29,1

56

50,8

41,2

21

38,3

59,5

54,3

0

10

20

30

40

50

60

70

80

Stunting Wasting Underweight Anemia in Children Anemia in Women(15 to 49 Years)

Perc

en

tag

e

NFHS 3 Urban NFHS 3 Rural NFHS 4 Urban NFHS 4 Rural

Key Nutritional Indicators in India

103

Prevent and reduce stunting

Children (0- 6 years)

Prevent and reduce under-nutrition

Children (0-6 years)

Reduce Low Birth Weight

Reduce anemia

Young Children(6-59 months)

Women & Adolescent Girls – 15 to 49 years

Bring down stunting of children 0-6 years from 38.4% to 25% by the year 2022

@ 2% per annum

@ 3% per annum

Targets

104

Undernutrition – Manifestations, Consequences, and Impact

Problem Manifestation Consequences Impact

Undernourishment

Micronutrient

deficiency

Wasting

Stunting

Small for gestation

age

Suboptimal

breastfeeding

Under 5 and

maternal deaths

Impaired physical &

cognitive

development

Decreased economic

activity

Compromised adult

health

High risk of

intergenerational

transfer

45% of under 5

mortality

22% of adult income

loss

IQ loss through

stunting (5-11 points)

Annual GDP loss of

11%

Every rupee invested

in nutrition yields a

return of Rs. 34 in

India

105

Counselling

• During pregnancy

• Optimal breastfeeding

• Complementary feeding

Vitamin A supplementation

Iron-Folic Acid supplementation

Supplementary Rations

Complementary food for Children

6-36 months

Treatment of Diarrhoea Deworming

CCT During Pregnancy, delivery

& Post Delivery

Additional Food Rations for

SAM & MAM

Insecticide‐treated nets for

pregnant women

Counselling5%

Supplementary Nutirtion

39%

Micronutrient & Deworming

3%

Health 4%

Meternity Benefits

49%

Interventions and Cost impact

106

36 States/UTs

719 Districts

7,075 Projects

51,328 Sectors

100 Million Beneficiaries

1.4 MillionField Functionaries AWW

Implementation

107

Technology

Convergence

Behavioral Change Communication

Capacity Building

The Four Pillars

Aanganwadi App

(Data Entry on ground)

1First Level Supervision

(Lady Supervisor)

2Tech Support

(Issue Tracker)

3

Real Time Data Offline-Online Multilingual Multimedia Tools GPS Tagging User Centric

Design

Multi-Layer Supervision

Dashboard

4

What is ICDS-CAS?

ICDS-CAS | AWW Application

110AWW DM/DPO/CDPO

State ICDS Directorate

Supervisor

Centre

Helpdesk

Beneficiaries

DashboardsCentral servers – Cloud Provider

AWW interacts and provides

service to a beneficiary

5

3

1

2

6

7

8

9

Data Fed by AWW is synced to

the server

Supervisor interacts with AWW

Supervisor interacts with

beneficiary

Supervisor syncs data onto the

sever

Helpdesk interactions for issue

resolution

Helpdesk syncs troubleshooting

information

Generation of dashboard reports

using data entered

Stakeholders access reports at

various administrative levels

1

2

3

4

5

6

7

8

9

Interactions Data flow

Process Flow

4

6

ICDS-CAS | Workflow

<Name> is severely underweight. Please contact your AWW immediately for necessary advice.

~1 Mn SMS

sent to

AWW & LS

SMS to Workers

~5 Mn SMS

sent to

Mothers

SMS to Beneficiaries

Centralized ICDS-CAS Call Centre set up by the Ministry for:

Toll-free number feedback for grievance handling

Follow-up with beneficiaries

Follow-up with officials about action taken on ground for identified

cases

1.5 Mn Calls made

Messages and Alerts | Prompting Action

~ 500,000 AWWs

26 States in India

285 Districts

~73.2 Mn Registered Households

~13.1 Mn Registered for

AWC Services

~46.7 Mn Children (0-6

yrs)

~4.6 Mn Pregnant

Women and Lactating

Mothers

ICDS-CAS Rollout | What are we talking about?

113

National

State

District

Block

Village

National CouncilExecutive Council

Convergence Action Plan

VHSN Day, CBE, DAY-NRLM

14000 Meetings

held in 2018-19

Convergence Platforms

114

Platforms

CBE - MonthlyVHSN Day - MonthlyDAY NRLM - Weekly

Trans-Media Campaigns

Nutrition Assemblies Nukkad NataksFestivals

Specific Days Like -• Yoga day• Breastfeeding week • Poshan Maah

Aligning FFs AWWs+LS+ASHA+ANM+SBPs – 2.4 Mn DAY-NRLM – 4.7 Mn Swachhagrahis – 0.4 Mn

Community Mobilization and Behavioural Change (Jan Andolan)Driven by Convergence ( Centre / State / District / Block / Village)

Health and

Family Welfare

Women and

Child

Development

Housing and

Urban Affairs

Rural

Development

Panchayati

Raj

Drinking Water

and

Sanitation

Human

Resource

Development

Information

and

Broadcasting

Consumer

Affairs,

Food and

Public

Distribution

Non

Renewable

Energy

Tribal AffairsMinority

Affairs

Ministries

115

Multi Sectoral

Themes

Behaviours

Messages

Platforms

Activities

Material

Behavioural Change Communication & Community Mobilisation

116

5THEMEFOCUS

DiarrhoeaManagement

Diet DiversityComplementary

Food & Feeding

AnemiaPrevention

1,000 Days

Hygiene, Sanitation &

Safe Drinking Water

D2 Camp-

Defeat Diarrhea

T3 Camp-

Test, Treat, Talk Anemia

Focus Themes for Community Mobilisation and BCC

117

Social Movement - Building A Common Understanding

JAN ANDOLAN/

SOCIAL MOVEMENT

Macro Level Meso & Micro Level

SBCC System

Strengthening

118

Incremental Learning Approach (ILA)

Field Functionaries Supervisory Staff State Level Staff

21 ILA Modules & 21 e-ILA + ECCE Modules

Monthly or Quarterly Module based Training

Maternal Nutrition

Newborn care

Breastfeeding

Complementary Feeding

Management of undernourished children

1 Mn FLW Trained

Capacity Building

1

2

3

4

5

Key Themes

119

Nutrition – Key Strategies and Interventions

120

Promoting Safe Drinking Water

Promoting SanitationODF

Promoting Personal HygieneHandwash facility with Soap

• Households• Anganwadi Centres• Health Centres• Schools

Infrastructure

Across1

2

3

A

121

Growth Monitoring & Promotion

Management of Acute Malnutrition

Breastfeeding • Within 1 hour of delivery• Exclusive Breastfeeding till 6 months

Service Delivery & Interventions

Complementary Feeding

Home Visits & Antenatal Check-ups

Institutional Deliveries

4

• Children 0-6 years• Weight and Height

• SAM and MAM Children

Anaemia

• Initiated at 6 months of age

• Children• Adolescent Girls• Mothers

5

6

7

8

9

10

B

• By AWW, ASHA & ANM• Counselling, HBNC, HBYC

122

Deworming

Diarrhoea Management

Calcium Supplement

• Children from 6 to 59 months• Adolescent Girls• Women of reproductive Age• Pregnant Women

Service Delivery and Interventions

Immunisation

Vitamin A Supplementation

Iron and Folic Acid

11

• Children till 1 year of age

• Actions Taken at State & District LevelFood Fortification

• Children from 6 to 59 months

• Children 1 to 19 years• February & August every year

12

13

14

15

16

17

C

• Pregnant Women (360 Tablets)

• Oral rehydration Solution • Zinc Supplementation

123

• Stocks of SNP

• Functional GMDs

• Availability of MCP Card

• Monitoring through ICDS-CAS

Supply Chain Management and Monitoring

Linked to ICDS

• IFA• Vitamin A• Calcium• Deworming Tablets• ORS & Zinc Supplement

Linked to Pharmaceuticals

D

124

THANK YOU

126

LUNCH


VIDEO

(Insert Lawrence Haddad

video here)

PANEL DISCUSSIONWhat we can do now, with what we have.

PANEL

132

GROW GREAT JOURNALISM AWARD


VIDEO

(Insert Bill Gates video)

134

CLOSING REMARKS


2019 GROW GREAT SEMINAR · 3 Micronutrient fortification (iron and salt iodization) Malnutrition 4...

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Transcript of 2019 GROW GREAT SEMINAR · 3 Micronutrient fortification (iron and salt iodization) Malnutrition 4...